DRUG PRICE TRANSPARENCY

Drug Price Transparency

Drug Price Transparency

Drug Price Transparency Leads to Cost Savings

Drug price transparency is a vital component in achieving healthcare price transparency. Drug price transparency is essential for consumers. Healthcare costs have experienced a dramatic increase over the past decade. Consumers are required to pay a greater percentage of cost-sharing while receiving a reduced benefit from their out-of-pocket expenditures.

ScriptSmart LLC uses proven methods to reduce consumer medical bills. We focus on reduced out-of-pocket expenses for medical bills including prescription drug costs.

Healthcare Price Transparency

Stakeholders Impact on Drug Price Transparency

Drug price transparency is essential for consumers to Control out-of-pocket costs. America’s Pharmaceutical System is a complex maze of interconnected organizations. Hard-working consumers are the source of their wealth. America holds more than 45 percent of the global pharmaceutical market. We spend over $500 billion on prescription drugs on an annual basis. The challenge is to discover effective methods to reduce unnecessary healthcare costs. If you don’t understand the system, you can’t reduce your healthcare. (New Report Finds COVID-19 Pandemic Causes Dramatic Shifts in Prescription Drug Spending, n.d.)

Lower Healthcare Costs Strategies Influencer
PHARMACY BENEFIT MANAGER SYSTEM

Pharmacy Benefit Manager

PBMs And Drug Price Transparency

PBMs oversee drug coverage for more than 280 million Americans. As a result, combined revenues exceed three-quarters of a trillion dollars. Express Scripts, CVS Caremark, and OptimumRx account for about 70% of all revenues. State and Federal regulators worry about mergers within the industry. (John Arnold, n.d.)

How PBMs Affect Drug Price Transparency

  • Lack of healthcare transparency relative to what drives medication costs
  • Rebates and Discount savings are not distributed to Consumers
  • Surprise billing at the point of sale often occurs
  • TV commercials mislead patients by omitting vital cost information

The Foundation For A Lower Health Cost Strategy

Lower Health Cost Strategy

Assume control of your monthly expenditures by using your communications skills. It’s important to find your voice to speak up for what’s beneficial.

How Prescribers Influence Drug Price Transparency

You must become your own advocate to save money on healthcare. Healthcare expenditures must be a budget priority. Scriptsmart LLC’s mission is coaching Consumers through the cost-savings process. Some tips how to lower healthcare costs are below:

  • Do your homework
  • Keep a list of your most expensive medications. It will be useful in discussions about costs with each of your Prescribers
  • Familiarize yourself with your Formulary. Important clues about costs may be available

How Prescriber Workflow Impacts A Lower Health Cost Strategy

Physicians prescribe medications without consideration of the economic impact on the patient. They are unaware of specific healthcare costs. You’ll save more money by discussing costs at an early stage. Your participation in the process is vital!

Pharmaceutical Sales Reps

Representatives educate Physicians about new developments in the Pharmaceutical Industry. They almost always leave behind a limited supply of “Samples”  for the Doctor to share with patients. 

The true healthcare costs of "samples"

CAUTION: There benefits and financial risks associated with samples. The benefit is that they’re free. The risks are the costs of refilling a prescription may be prohibitive!

  • THERE IS NO MAGIC BULLET!
  • The Prescriber has no idea what the copay might be even if the patient has insurance
  • Your Insurance Carrier may not include the drug in your Formulary
  • The drug may require Prior Authorization, Step Treatment, or have a Dosage limit
  • The new drug may be listed in your highest copay Tier within your Formulary

Sticker Shock

(What was your reaction the last time a stunned Pharmacy Technician whispered, “are you aware of the copay for this new medication?”)

Extra factors influencing a healthcare costs savings strategy

Contemporary trends in healthcare costs escalation reflect a steady decline in overall Healthcare coverage. Coverage for prescription drugs has become more restrictive. 

PBMs oversee drug coverage for more than 280 million Americans. As a result, combined revenues exceed three-quarters of a trillion dollars. Express Scripts, CVS Caremark, and OptimumRx account for about 70% of all revenues. State and Federal regulators worry about mergers within the industry. (John Arnold, n.d.)

Many patients on fixed incomes find it more difficult to preserve their healthcare budget. costs of important medications inflation by double digits. 

Common reactions to surprise billing

Consumers coping with rising prices for important medications often take drastic measures. Failure to follow your Doctor’s orders can result in dire consequences. Examples of Consumer reactions are below:

  • Rationing
  • Skip taking drug
  • Use discount cards
  • Take part in Manufacturer’s Subsidy Program
  • Borrow to make payments
  • Shopping for the best prices
  • Abandonment

 

Rationing and skipping medications

can't afford prescription

The Journal of the American Medical Association (JAMA)  suggests rationing is quite common.

Transparent pricing in healthcare is becoming more important with prescription drugs. Greater costs forced an increasing number of patients to cease taking one or more prescribed drugs due to costs.
Faced with budget-busting prescription costs, many patients simply walk away from certain treatments. Few Physicians even discuss the cost of healthcare with a patient during an appointment.

ABANDONMENT

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69% of patients are likely to abandon a medication once cost sharing reaches $250. 08/19 IQIVA Institute for Human Data Science Report)

Transparent pricing in healthcare is becoming more important with prescription drugs. Greater costs forced an increasing number of patients to cease taking one or more prescribed drugs due to costs.

Faced with budget-busting prescription costs, many patients simply walk away from certain treatments. Few Physicians even discuss the cost of healthcare with a patient during an appointment. Transparent pricing in healthcare is becoming more important with prescription drugs. Greater costs forced an increasing number of patients to cease taking one or more prescribed drugs due to costs. Faced with budget-busting prescription costs, many patients simply walk away from certain treatments. Few Physicians even discuss the cost of healthcare with a patient during an appointment.

Shopping as part of a lower healthcare costs strategy

Healthcare is a commodity. Prices for services vary widely. Therefore, it is always to shop for the best deal! Shopping for the best cost-savings options is one of the services available through Scriptsmart LLC!

Issues with prescription imports

Consumers face two obstacles to financial relief through imports. One is the Drug Lobby PHARMA; The other is Congress. PHARMA has exclusive control over both ends of the supply chain; Manufacturing and Distribution. They don’t intend to lose money on either end! Congress is heavily influenced by millions of dollars distributed for campaigns and financial favors. States cannot import drugs without Congressional approval. Even the White House is attempting to enter the playing field, further clouding the waters. The bottom line is nothing is easy on a national scale.

CONCLUSION

Waiting for a “Fix” provided by Congress and the White House is fruitless. Scriptsmart LLC will guide you through the steps required to achieve your objective of significant costs reductions. ACT NOW! Call us at (877) 436-9111. Like us on Face book at Script Smart LLC or follow us on Twitter @scriptsmartllc

Sources:

John Arnold. (n.d.). Are pharmacy benefit managers the good guys or bad guys of drug pricing? – STAT. STAT. Retrieved September 27, 2021, from https://www.statnews.com/2018/08/27/pharmacy-benefit-managers-good-or-bad/

Neuman, T., & Cubanski, J. (n.d.). Price Increases Continue to Outpace Inflation for Many Medicare Part D Drugs | KFF. Kaiser Family Foundation. Retrieved September 27, 2021, from https://www.kff.org/medicare/issue-brief/price-increases-continue-to-outpace-inflation-for-many-medicare-part-d-drugs/

New Report Finds COVID-19 Pandemic Causes Dramatic Shifts in Prescription Drug Spending. (n.d.). American Society of Health-System Pharmacists. Retrieved September 27, 2021, from https://www.ashp.org/news/2021/04/21/new-report-finds-covid19-pandemic-causes-dramatic-shift-in-prescription-drug-spending?loginreturnUrl=SSOCheckOnly

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